瑞马唑仑在喉罩全身麻醉中的应用进展
Advances in the Application of Remimazolam in Laryngeal Mask Airway General Anesthesia
DOI: 10.12677/acm.2026.161182, PDF,   
作者: 李雯静, 刘 苗：吉首大学医学院，湖南 吉首；贺 涛*, 杨 诞：娄底市中心医院麻醉科，湖南 娄底
关键词: 瑞马唑仑；喉罩；全身麻醉；麻醉诱导；ERAS；Remimazolam； Laryngeal Mask Airway； General Anesthesia； Induction of Anesthesia； ERAS
摘要: 瑞马唑仑作为一种新型超短效苯二氮䓬类静脉麻醉药，具有起效迅速、代谢不依赖肝肾功能、对循环与呼吸影响轻微、且可被氟马西尼特异性拮抗等优势。与创伤小、操作简便的喉罩(LMA)气道管理技术结合后，更契合加速康复外科(ERAS)理念，为临床提供了理想的全身麻醉策略。本综述系统总结了瑞马唑仑在喉罩全身麻醉中的最新研究进展，重点围绕其药理特点、麻醉诱导方案、在不同手术类型中的应用效果及相关不良反应，并对潜在风险及未来发展方向进行分析与展望，以期为临床实践提供参考依据。
Abstract: Remimazolam, a novel ultra-short-acting benzodiazepine intravenous anesthetic, offers several unique advantages, including rapid onset, metabolism independent of hepatic or renal function, minimal cardiopulmonary depression, and specific reversibility by flumazenil. When combined with laryngeal mask airway (LMA) management—which is minimally invasive and easy to operate—remimazolam provides an anesthesia strategy well aligned with the principles of enhanced recovery after surgery (ERAS). This review summarizes current advances in the use of remimazolam for LMA-based general anesthesia, focusing on its pharmacological properties, induction strategies, clinical applications across various surgical settings, and associated adverse events. Potential risks and future clinical prospects are also discussed, aiming to provide evidence-based guidance for its clinical use.
文章引用：李雯静, 贺涛, 刘苗, 杨诞. 瑞马唑仑在喉罩全身麻醉中的应用进展[J]. 临床医学进展, 2026, 16(1): 1414-1422. https://doi.org/10.12677/acm.2026.161182

参考文献

[1] Beilstein, C.M., Wuethrich, P.Y., Furrer, M.A. and Engel, D. (2022) Comments on “Essential Elements of Anaesthesia Practice in ERAS Programs” and “Tips and Tricks in Achieving Zero Peri-Operative Opioid Used in Onco-Urologic Surgery”. World Journal of Urology, 40, 2357-2358. [Google Scholar] [CrossRef] [PubMed]
[2] Masui, K. (2024) Remimazolam: Its Clinical Pharmacology and Evolving Role in Anesthesia and Sedation Practice. Current Opinion in Anaesthesiology, 37, 344-351. [Google Scholar] [CrossRef] [PubMed]
[3] Stöhr, T., Colin, P.J., Ossig, J., Pesic, M., Borkett, K., Winkle, P., et al. (2021) Pharmacokinetic Properties of Remimazolam in Subjects with Hepatic or Renal Impairment. British Journal of Anaesthesia, 127, 415-423. [Google Scholar] [CrossRef] [PubMed]
[4] Pan, Y., Chen, M., Gu, F., Chen, J., Zhang, W., Huang, Z., et al. (2022) Comparison of Remimazolam-Flumazenil versus Propofol for Rigid Bronchoscopy: A Prospective Randomized Controlled Trial. Journal of Clinical Medicine, 12, Article 257. [Google Scholar] [CrossRef] [PubMed]
[5] Goertzen, C., Goertzen, E., Zanjir, M., Dare, C., Azarpazhooh, A. and Wong, M. (2024) Comparison of Anesthetics for Laryngeal Mask Airway Insertion: A Network Meta-Analysis. Anesthesia Progress, 71, 58-75. [Google Scholar] [CrossRef] [PubMed]
[6] Brohan, M., Brohan, J. and Goudra, B. (2024) Remimazolam and Its Place in the Current Landscape of Procedural Sedation and General Anesthesia. Journal of Clinical Medicine, 13, Article 4362. [Google Scholar] [CrossRef] [PubMed]
[7] Kim, S. and Fechner, J. (2022) Remimazolam—Current Knowledge on a New Intravenous Benzodiazepine Anesthetic Agent. Korean Journal of Anesthesiology, 75, 307-315. [Google Scholar] [CrossRef] [PubMed]
[8] Kim, K.M. (2022) Remimazolam: Pharmacological Characteristics and Clinical Applications in Anesthesiology. Anesthesia and Pain Medicine, 17, 1-11. [Google Scholar] [CrossRef] [PubMed]
[9] Chen, Y., Gong, C., Liu, F., Jiao, Z. and Zheng, X. (2024) Toward Model-Informed Precision Dosing for Remimazolam: A Population Pharmacokinetic-Pharmacodynamic Analysis. Pharmaceutics, 16, Article 1122. [Google Scholar] [CrossRef] [PubMed]
[10] Birgenheier, N.M., Stuart, A.R. and Egan, T.D. (2020) Soft Drugs in Anesthesia: Remifentanil as Prototype to Modern Anesthetic Drug Development. Current Opinion in Anaesthesiology, 33, 499-505. [Google Scholar] [CrossRef] [PubMed]
[11] Schüttler, J., Eisenried, A., Lerch, M., Fechner, J., Jeleazcov, C. and Ihmsen, H. (2020) Pharmacokinetics and Pharmacodynamics of Remimazolam (CNS 7056) after Continuous Infusion in Healthy Male Volunteers: Part I. Pharmacokinetics and Clinical Pharmacodynamics. Anesthesiology, 132, 636-651. [Google Scholar] [CrossRef] [PubMed]
[12] Monanian, G., Yonel, B., Rupert, D., Razak, A., DeLemos, M. and Bergese, S.D. (2025) Evaluating Remimazolam for Procedural Sedation. Current Neuropharmacology, 23, 1009-1020. [Google Scholar] [CrossRef] [PubMed]
[13] Kilpatrick, G.J. (2021) Remimazolam: Non-Clinical and Clinical Profile of a New Sedative/Anesthetic Agent. Frontiers in Pharmacology, 12, Article 690875. [Google Scholar] [CrossRef] [PubMed]
[14] Chae, D., Kim, H.C., Song, Y., Choi, Y.S. and Han, D.W. (2022) Pharmacodynamic Analysis of Intravenous Bolus Remimazolam for Loss of Consciousness in Patients Undergoing General Anaesthesia: A Randomised, Prospective, Double-Blind Study. British Journal of Anaesthesia, 129, 49-57. [Google Scholar] [CrossRef] [PubMed]
[15] Jeong, H., Kim, H. and Ahn, H.J. (2023) An Adequate Infusion Rate of Remimazolam for Induction of General Anesthesia in Adult Patients: A Prospective Up-And-Down Dose-Finding Study. Journal of Clinical Medicine, 12, Article 1763. [Google Scholar] [CrossRef] [PubMed]
[16] Cai, Y.H., Dong, L.Q., Zhong, J.W., Lin, Z., et al. (2025) ED50 and ED95 of Remimazolam for Loss of Consciousness in Young Children: A Dose-Finding Study for Induction of Anaesthesia. British Journal of Anaesthesia, 134, 1709-1716. [Google Scholar] [CrossRef] [PubMed]
[17] Li, H., Wang, J., Wei, R. and Jiang, Y. (2024) Median Effective Dose of Remimazolam Combined with Sufentanil for Inhibiting Laryngeal Mask Airway Insertion Responses in Children of Different Ages. Frontiers in Pharmacology, 15, Article 1506209. [Google Scholar] [CrossRef] [PubMed]
[18] 刘佳, 张二飞, 王丽, 邢东, 聂煌. 苯磺酸瑞马唑仑抑制老年患者喉罩置入心血管反应有效剂量的测定[J]. 华西医学, 2024, 39(2): 240-244.
[19] Wang, S., Wang, W., Xiao, J., Yu, H., Zhou, H. and Xu, H. (2022) Determination of the Median Effective Dose of Sufentanil for Inhibiting the Laryngeal Mask Insertion Response in Geriatric Patients: A Prospective, Double-Blinded, Dose-Response Trial. BMC Anesthesiology, 22, Article No. 216. [Google Scholar] [CrossRef] [PubMed]
[20] Xu, Q., Qian, J., Zhang, S.Q., Xia, F., Hu, H. and Xiao, F. (2025) Dose-Response Study of Remimazolam Combined with Remifentanil for Attenuating Stress Response during Laryngeal Mask Airway Insertion in Elderly Female Patients: A Prospective Double-Blinded Study. Drug Design, Development and Therapy, 19, 1575-1583. [Google Scholar] [CrossRef] [PubMed]
[21] Oh, J.Y., Park, S.Y., Moon, J.Y., Park, J.H. and Joe, H.B. (2024) The Effect of Sex on the Remimazolam Dosage Required for Successful I-Gel Supraglottic Airway Insertion with Remifentanil in Non-Paralyzed Patients: An Up-and-Down Sequential Allocation Trial. Journal of Clinical Medicine, 13, Article 670. [Google Scholar] [CrossRef] [PubMed]
[22] Kim, J., Lee, S., Kim, Y. and Jeong, J.S. (2023) Remimazolam Dose for Successful Insertion of a Supraglottic Airway Device with Opioids: A Dose-Determination Study Using Dixon’s Up-and-Down Method. Canadian Journal of Anesthesia, 70, 343-350. [Google Scholar] [CrossRef] [PubMed]
[23] Choi, J.J., Jung, W.S., Chang, Y.J., Yoo, S. and Kwak, H.J. (2023) Effective Concentration of Remifentanil for Successful I-Gel Insertion during Remimazolam Induction. Korean Journal of Anesthesiology, 76, 235-241. [Google Scholar] [CrossRef] [PubMed]
[24] Huang, Y., Liao, H., Li, L., Xu, J., Jiang, P., Guo, Y., et al. (2024) Minimal Alveolar Concentration of Sevoflurane in Combination with Remimazolam in Adults during Laryngeal Mask Insertion: An Up-Down Sequential Allocation Study. BMC Anesthesiology, 24, Article No. 94. [Google Scholar] [CrossRef] [PubMed]
[25] 胡春华, 王古岩, 王惠军, 奚春花, 张丛雅, 吴黎黎. 瑞马唑仑复合地氟烷全身麻醉联合氟马西尼拮抗在眼科日间手术中的应用[J]. 实用医学杂志, 2024, 40(4): 537-542.
[26] Zhang, S., Liu, Y., Liu, Y. and Xu, T. (2025) The Recovery of Ciprofol, Remimazolam and Remimazolam-Flumazenil for General Anesthesia Undergoing Fundus Surgery: A Single-Center, Prospective, Randomized, Controlled Clinical Study. Drug Design, Development and Therapy, 19, 3691-3700. [Google Scholar] [CrossRef] [PubMed]
[27] Qin, J., Gan, W., Liu, Q., Zhang, X., Li, X., Lu, B., et al. (2025) Emergence Profiles of Remimazolam-Flumazenil versus Propofol in Pediatric General Anesthesia for Strabismus Correction: A Randomized Clinical Trial. BMC Anesthesiology, 25, Article No. 218. [Google Scholar] [CrossRef] [PubMed]
[28] Chen, H.Y., Wang, H.J., Xi, C.H., Wang, Y., et al. (2024) Comparison of the Effects of General Anesthesia between Remimazolam and Propofol in Pediatric Patients Undergoing Binocular Strabismus Day Surgery. National Medical Journal of China, 104, 2728-2733.
[29] 江漩, 郑小艳, 嵇富海, 毕国荣, 李健, 朱晓刚. 瑞马唑仑联合瑞芬太尼在泌尿外科短小手术中的研究[J]. 中国药学杂志, 2021, 56(22): 1840-1843.
[30] 周军, 尹波, 许毓光, 曾娟. 瑞马唑仑复合瑞芬太尼喉罩静脉全身麻醉用于老年输尿管镜碎石取石术中的安全性及有效性观察[J]. 中国医刊, 2022, 57(4): 405-408.
[31] Fujimoto, D., Obata, N. and Mizobuchi, S. (2024) Effectiveness of Remimazolam in Preventing Postoperative Delirium in Elderly Patients with Proximal Femoral Fractures. Journal of Anesthesia, 38, 475-482. [Google Scholar] [CrossRef] [PubMed]
[32] Zhang, J., Wang, X., Zhang, Q., Wang, Z. and Zhu, S. (2022) Application Effects of Remimazolam and Propofol on Elderly Patients Undergoing Hip Replacement. BMC Anesthesiology, 22, Article No. 118. [Google Scholar] [CrossRef] [PubMed]
[33] Duan, J., Ju, X., Wang, X., Liu, N., Xu, S. and Wang, S. (2023) Effects of Remimazolam and Propofol on Emergence Agitation in Elderly Patients Undergoing Hip Replacement: A Clinical, Randomized, Controlled Study. Drug Design, Development and Therapy, 17, 2669-2678. [Google Scholar] [CrossRef] [PubMed]
[34] Tang, S., Lu, J., Xu, C., Wei, L., Mei, S., Chen, R., et al. (2023) Feasibility and Safety of Remazolam versus Propofol When Inserting Laryngeal Masks without Muscle Relaxants during Hysteroscopy. Drug Design, Development and Therapy, 17, 1313-1322. [Google Scholar] [CrossRef] [PubMed]
[35] 李学伦, 李文醒, 张琼丽, 冯超群. 瑞马唑仑复合舒芬太尼喉罩全身麻醉在宫腔镜检查中的应用效果及对患者复苏质量的影响[J]. 临床合理用药, 2023, 16(20): 108-110.
[36] Lee, J., Kim, D.H., Ju, J.W., Nam, K., Cho, Y.J., Jeon, Y., et al. (2024) Comparison of Recovery Profiles between Total Intravenous Anaesthesia with Propofol or Remimazolam Reversed with Flumazenil in Patients Undergoing Breast Surgery: A Randomised Controlled Trial. European Journal of Anaesthesiology, 41, 199-207. [Google Scholar] [CrossRef] [PubMed]
[37] Xie, M., Meng, Y. and Pei, H. (2024) Thoracoscopic Wedge Resection of the Upper Lobe of the Left Lung Achieved by a New Approach of Laryngeal Mask General Anesthesia with Preservation of Spontaneous Breathing: A Case Report. Medicine, 103, e39172. [Google Scholar] [CrossRef] [PubMed]
[38] 张维义, 哈思远, 苑广超, 王芳, 夏维. 瑞马唑仑对颅内动脉瘤介入治疗围手术期血流动力学的影响[J]. 中国临床神经外科杂志, 2022, 27(8): 684-686.
[39] Zhang, L., Wang, Z., Liu, Y., Zhang, X. and Wu, Y. (2024) Comparison of Remimazolam Tosilate and Propofol Sedation on the Early Postoperative Quality of Recovery in Patients Undergoing Day Surgery: A Prospective Randomized Controlled Trial. Drug Design, Development and Therapy, 18, 1743-1754. [Google Scholar] [CrossRef] [PubMed]
[40] Oh, E.J., Chung, Y.J., Lee, J., Kwon, E.J., Choi, E.A., On, Y.K., et al. (2023) Comparison of Propofol Vs. Remimazolam on Emergence Profiles after General Anesthesia: A Randomized Clinical Trial. Journal of Clinical Anesthesia, 90, Article 111223. [Google Scholar] [CrossRef] [PubMed]
[41] Park, I., Cho, M., Nam, S.W., Hwang, J., Do, S. and Na, H. (2022) Total Intravenous Anesthesia Induced and Maintained by a Combination of Remimazolam and Remifentanil without a Neuromuscular Blocking Agent: A Prospective, Observational Pilot Study. BMC Anesthesiology, 22, Article No. 237. [Google Scholar] [CrossRef] [PubMed]
[42] Vellinga, R., Koomen, J.V., Eleveld, D.J., Stöhr, T., Pesic, M., Struys, M.M.R.F., et al. (2024) Target-Controlled Infusion of Remimazolam in Healthy Volunteers Shows Some Acute Tolerance. Anesthesiology, 140, 207-219. [Google Scholar] [CrossRef] [PubMed]
[43] Liu, H., Li, Z., Yan, S. and Ming, S. (2025) Adverse Event Signal Analysis of Remimazolam Using the fda Adverse Event Reporting System Database. Acta Anaesthesiologica Scandinavica, 69, e14588. [Google Scholar] [CrossRef] [PubMed]
[44] Tsurumi, K., Takahashi, S., Hiramoto, Y., Nagumo, K., Takazawa, T. and Kamiyama, Y. (2021) Remimazolam Anaphylaxis during Anesthesia Induction. Journal of Anesthesia, 35, 571-575. [Google Scholar] [CrossRef] [PubMed]
[45] Lee, J. and Kim, S.H. (2024) Remimazolam-Induced Anaphylaxis and Cardiovascular Collapse: A Narrative Systematic Review of Eleven Cases. Medicina, 60, Article 971. [Google Scholar] [CrossRef] [PubMed]
[46] Nakai, T., Kako, E., Ota, H., So, M. and Sobue, K. (2024) Remimazolam Anaphylaxis in a Patient Not Allergic to Brotizolam: A Case Report and Literature Review. BMC Anesthesiology, 24, Article No. 204. [Google Scholar] [CrossRef] [PubMed]

为你推荐